Breathing treatment (nebulizer)
Facility: Decatur Health
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $148
- Cash Discount Price: $175
- vs. Medicare Baseline: 0.66x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $223.72 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $54 | 24% |
| Wppa/Providrs Care- All Plans | $117 | 52% |
| UnitedHealthcare | $118 - $148 | 53% |
| Humana | $120 | 54% |
| Aetna | $175 - $194 | 78% |
| Midlands Choice- All Plans | $175 | 78% |
| Medicaid / KanCare | $196 | 88% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Decatur Health in Oberlin, KS, lists a cash median price of $175.00, which is lower than the facility's gross charge of $194.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $118 to $196, the cash price may offer a more affordable option for patients with high-deductible plans or those without insurance, as it avoids the administrative overhead and markup often found in insurance contracts. It is important to note that commercial negotiated rates frequently exceed cash prices due to the costs of claims processing and utilization reviews, making direct payment a potential strategy to reduce out-of-pocket expenses if the patient's insurance allowed amount is higher than the cash rate.
To ensure you are receiving the most accurate and lowest possible price, we recommend requesting a prompt-pay discount from the facility before scheduling your visit, as these upfront incentives can significantly reduce the final bill. Additionally, if you are billed by an out-of-network provider or receive unexpected charges, you should request a full itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. Finally, when evaluating the facility's pricing structure, it is more meaningful to compare rates against the Medicare benchmark of $223.72 rather than the inflated chargemaster list price, as Medicare rates represent a scientifically validated baseline for the true cost of care delivery.